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Application for removal of stainless steel patties/pattas manufactured under the
special procedure

Name of the Factory.

Address.
1.
I/We..manufacturer(s) of stainless steel
patties/pattas
residing
at.Taluka/TehsilDistrict
and holder(s) of Central Excise Registration No. dated..having
been permitted to avail myself/ourselves of the special procedure contained in the
notification issued under rule 15 of Central Excise (No.2) Rules 2001, in respect of
my/our production and transactions in such stainless steel patties/pattas at the
above-mentioned factory/factories hereby declare that I /we intend to instal and
employ the cold rolling machines for the production of stainless steel patties/pattas
during the yearin the manner indicated below, and the total sum payable
by me/us in terms of the provisions laid down in the notification in respect of the said
period are stated hereunder:-

No.of cold rolling

Machines to be
installed
and employed
(1)

2.

Rate prescribed in Government

of India
Notification No. /2001- Central
Excise dated
(2)

Sum
payable
(3)

Total

(4)

I/We tender herewith the sum of Rs..(Rupees.only). The

balance will be paid by me/us in monthly instalments.

3. I/We hereby declare that the particulars furnished herein are true and
complete to the best of my/our knowledge and belief.
4. I/We apply for leave to remove from the above mentioned premises during the
period from .to.any stainless steel patties/pattas manufactured in
the said premises during that period.
5. I/We understand that the permission accorded to me/us for the year.is
subject to my/our paying the balance amount as indicated in paragraph 2
above.

Place.
Date
Signature of manufacturer or his authorized agent.
To
The Superintendent of Central Excise
.Range
.Division
COUNTERSIGNED
Place..
Date
Superintendent of Central Excise
..Range
..Circle.
Statement of duty paid:
(a)
For payment in cash at..
Treasury
State Bank of India
Reserve Bank of India
(To be filled in by the manufacturer or his authorised agent)
Name of person tendering
payment
(1)

Particulars of
payment
(2)

Amount(in words as well as in

figures)
(3)

Head of Account
038-Union Excise Duties- Stainless steel patties/pattas
(b)
Under the compounded levy scheme.
Date..
Signature of the tenderer
(To be filled in by the Treasury or Bank)
CERTIFICATE
Deposit NumberDate.Received payment of rupees (in
words).
Signature of Treasurer
or Accountant
Agent or Manager
(c)

For payment through account-current:

Title of Account of
Ledger
(1)
Place
Date.
(d)

Number and date of

entry
(2)

Amount (in words as well as in

figures
(3)

Signature of the manufacturer or his Authorized

agent.
For payment through T.R.5/Special Revenue Money Order

Date of
Payment
(1)
Place..
Date

T.R.5 No./Special Money Order

Coupon No.
(2)

Amount(in words as well

as in
figures)
(3)

Clearance allowed subject to fulfillment of the condition of deposits

Superintendent of Central Excise
Note: Delete the entries not applicable.